الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
ChapterXII
Conclusion and summary
The biofragmentable anastomotic ring (Valtrac; Davis and Geek,
Wayne, New Jersey, USA) is a device used to construct an inverting
intestinal anastomosis. It is composed of polyglycolic acid and barium
sulphate, and provides a mechanically locking connection that maintains
the serosal surfaces of the bowel ends in apposition until healing occurs.
Once the two caps of the ring are inserted into the ends ofthe bowel and
the purse-string sutures are tied snugly around the device, the ring is
locked by pressing on its caps until they are approximated and ”click”
together. However, the instruction manual for the Valtrac ring points:
”...click may occur infrequently in the absence of secure closure.
Secure closure may occur in the absence of a click. Inspection and gentle
traction are recommended to reassure the surgeon that proper closure has
been obtained.”
A simple method of testing the closure of the ring without risking
disruption of the anastomosis has been devise, the ring is grasped with
the index and middle fingers and the thumb at the junction between the
two caps and gentle pressure applied tangentially. If closure is not
secure, the two caps separate easily and another attempt can be made to
close them.
In all cases of faulty closure, reapproximation of the caps was
successful on a second attempt. The manual compression needed to
effect closure of the device when performing the anastomosis may worry
surgeons, however, and the narrower internal lumen of anastomosis with
the BAR compared with a manual suture of the same external diameter
may increase the risk of post operative obstruction or stricture formation.
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Chapter XII
We have not found an increased risk of complications during or after
operation with the BAR; indeed, the ring made anastomosis easier in
some patients compared with manual sutures.
There were no early clinical or subclinical leaks, nor any late leaks
following fragmentation ofthe device. Reservation about the integrity of
sutureless anastomosis are therefore unfounded. Use of the BAR has
positive advantages, and the fear of anastomotic complications appear to
be groundless.
This experience seems to confirm, with other authors, that BAR
provides an effective anastomosis method: it gives a completely inverted,
nonischaemic anastomosis, without additional incision nor residual
foreign bodies. It shortens operating times and its technique seems to be
easy to learn and to perform. Complications and mortality are not
increased even in case of multiple anastomosis.